Healthcare professionals’ perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation: A systematic review

The real barrier is that they are just guidelines, the researchers didn't do their jobs properly and hand over fully complete protocols.  With protocols you'll know they work and survivors will gladly do the reps necessary to recover. Do you blithering idiots ever think at all?

 Healthcare professionals’perceived barriers and facilitators of implementing clinical practice guidelines for stroke rehabilitation:
A systematic review

Healthcare professionals’ perceived barriers and facilitators of implementing clinical practice
guidelines for stroke rehabilitation:
A systematic review
Adrienne Cormican 1 , Shashivadan P Hirani2 ,
and Eamonn McKeown

Abstract

Objective:  

To identify healthcare professionals’ perceived barriers and facilitators to clinical practice
guideline implementation within stroke rehabilitation.
Data sources: CINAHL, MEDLINE, EMBASE, AMED, Cochrane library, Academic Search Complete and
Scopus.  

Additional papers were identified through hand searching.
Review methods: 

 The review followed the Preferred Reporting Item for Systematic Reviews and Meta-
Analysis Protocols systematic review approach. Any empirical research that provided qualitative data on
healthcare professionals’ perceived factors influencing clinical guideline implementation in stroke rehabili-
tation was included. One reviewer screened all titles and abstract reviews (n = 669). Another two
reviewers independently screened 30% of title and abstract reviews, followed by full-text reviews (n = 61).
Study quality was assessed using the mixed-method appraisal tool.
Results:  

Data from 10 qualitative, six quantitative and six mixed-method studies published between
2000 and 2022, involving 1576 participants in total, were analysed and synthesised using modified thematic synthesis approach. The majority of participants were therapists n = 1297 (occupational therapists, physiotherapists, speech and language therapists). Organisational factors (time constraints,
resources) alongside healthcare professionals’ lack of knowledge and skills were the most cited barriers to guideline implementation. Contradictory attitudes and beliefs towards stroke guidelines applicability to real-life clinical practice and their evidence base were reported. Organisational support in the form of training, local protocols, performance monitoring and leadership were reported as perceived facilitators.

Conclusion:  

Barriers and facilitators are multifactorial and were identified at guideline, individual, team and organisational levels. There is a need to translate perceived barriers and facilitators into implementation interventions especially addressing organisational level barriers.